Cambridge, MA – The factors behind trends in medical payments per claim in state workers’ compensation systems and the impact of legislative and regulatory changes on those costs are examined in a new set of studies released by the Workers Compensation Research Institute (WCRI).
The studies, CompScope™ Medical Benchmarks, 20th Edition, examine trends in payments, prices, and utilization of medical care for workers injured on the job. They provide analyses of recent costs and trends for policymakers and other system stakeholders, reporting how medical payments per claim and cost components vary over time and from state to state.
“The reports are useful to identify where medical cost and care patterns may be changing,” said Ramona Tanabe, executive vice president and counsel for WCRI. “They also help identify where medical payments per claim or utilization may differ from other states.”
The following are sample findings for some of the study states:
- California: California saw moderate growth in medical payments per claim with more than seven days of lost time in 2017, after a decrease following the implementation of Senate Bill (SB) 863. Other policy changes that may influence the recent trends in California include two major fraud-fighting measures ─ Assembly Bill (AB) 1244 and Senate Bill 1160, the drug formulary required by AB 1124, and multiple medical fee schedule updates.
- Florida: Medical payments per claim in Florida have been typical of 18 states, a result masking the lowest prices paid for nonhospital professional services and higher-than-typical payments per claim for ambulatory surgery centers (ASCs) and for hospital outpatient and inpatient services. These results were mainly related to fee regulations in the state.
- Illinois: The average medical payment per claim with more than seven days of lost time in Illinois was more than 15 percent higher than the median of 18 states studied for claims at 12 months of experience. This result reflects a combination of higher prices paid for many professional services and higher utilization of medical services than in other study states.
- Minnesota: Medical payments per claim in Minnesota remained stable from 2012 to 2017. Several trends offset one another to produce the stable results. For example, hospital inpatient payments per episode decreased following the 2016 inpatient fee schedule change, while ASC and hospital outpatient facility payments per claim increased.
- North Carolina: Medical payments per claim in North Carolina decreased 5 to 7 percent per year since 2014. These decreases likely reflect 2015 Medicare-based fee schedule changes for hospitals, ASCs, and nonhospital (professional) services.
- Wisconsin: Medical payments per claim in 2017 increased following two years of little change. The growth stemmed from several underlying factors: a larger recent increase in workers’ compensation medical prices paid for nonhospital care, an increase in hospital outpatient payments per service, and an increase in medical payments for inpatient episodes, especially surgical.
The studies cover the period from 2012 through 2017, with claims experience through March 2018. The 18 states in the study ― Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin ― represent more than 60 percent of the nation’s workers’ compensation benefit payments. Individual reports are available for every state except Arkansas and Iowa.
For more information: WCRI: CompScope™ Medical Benchmarks, 20th Edition